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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS OWNER AUILDTJR DELCARA'TION
<br />I h.rcby rrtr uMcr p€nalry ol p.rjxry
<br />'hd
<br />I mr cx.n1fl lmn rhc ContacroB Liccns ti{ inr the hllowinE @son (Scc.703l 5
<br />ausnrss and Pbrdsion c.dc) Any Cny or Counly *hi.h rcquncs a pcirnn lo onnru.l. ahcr. inrprolc. dcnnnh or Eirn uy
<br />srdclurc, riffro nr issuaNc. also rcquncs lhc np,'licant lor such l)cfln ro nbasisned ilarcmnr rhd hcorsh. is li.c.scd tuBxr.r
<br />lo rhc pmvii,ns of rhc Conrn.roi s Liccnrd L,w (Chapr.r 9. C.nnncncrg wirh Scction 7U)0 oi Division I otrh. BusirrcN rnd
<br />Pofe$ions Codc) or rhat tr or shc h cxempl lhcrcrionrand rhc b.sn for lnc lllcscd c$mrrion An, vn,hrionorserionToll5 by a,ry
<br />rptl.!qrr'nrrflrnir\uh|.cr.rl. rnrhtrnrl,rti!ilpcnrlry rrormn.,liltrrhd rJd.llrF'1rUU,,fN
<br />,"-+. as owncr ol rhc poFny. or my empbyces *ith wases r( lhcn $t onrFnsalii'n, willd() rhc *mt a,rl rh str(m,s mr
<br />inrcftlc or olTcrcd ntr sb (56 7l}ll.1, Bu:inc$ rtrd Pr.rcs\i,n* C(xlc: Thc Conlricror'\ Li.cnsc L.w docs nor oplly ro ano{ncrof
<br />rh. l,otEny who t{ilds or irym6 rhcFr- and *ho des suh $ort himscllnr h.rtltor rlYouSh ht or hcr.wn cmPloyccs.
<br />pmlidcd rhar s&h impmlctunk m nor inrcndcd oi offcrcd ru slc Il lwcwr. lhc hoildinS or impmvcm i\ y,ld wirhin .m Fd
<br />olcorqrlction. r1r Owm. auikhr rillltrrc Ihc hrdcn ol pmving rhal l.c or shc dil ml buikr or inpoft rhc tn)rdy ror 0r lu.lFs ol
<br />_1.r\.sncrorrtunm|rny.anrcrrlu\irclyconki.ring*irIlicc\cd.ofir.nn!h.onsru.rrhcln)jcd(SLr7(].lt-Burncs
<br />rndI'nii:\\hiCodcThcCotrrmnn\l-i.ctr\cLr*doc\notrnrlybrnosrcrotnropcnyshobuild\ornpn,(csrh.rcor.
<br />nJ *ho.onrrcr\rn{'chl,n,jccr\wirhrC.ntact,r\)lic.n\cdnursunDrhrhecoDrdolsLl.cn$L.s)
<br />-l
<br />nmc\ctrv undcrs(rio
<br />d,",.5lihl_LK X"t!4]!xD[ti:11[urr5 -l!a!DrcLlXAl!!)!
<br />I hrrrh'Jil nnunJrrI[tr,'l(!olItrrlurto crlrhcl,rl({!i'rgtlr.hrrri,nr\
<br />-l
<br />hrvc 0ndwill nrinrain aCedilrarcofConscnr ro Seltlnsure lorsorlcn c.mp.nsdn,n.as pmvidcd lor byS..lion 3100 ol'lhc
<br />tjtxtr Codc, lor rh. p.rfrnEncc ol rhe work ld which ihc rrmil n nlucd.
<br />Ihrvcrnd\ill,mi'riiworkc.r..nip.tr\nri{,nin\urnt,r\rcqutdhyScdn:l?Ur.lrhct-rhor(ir.larrhlFrlornri..ol
<br />rhc{orklar{hthrhnplrnririsi\sucd.Mtaolkc^..rr^-isit. ruflmc .rtricr ml Ix) li.y nunrh.r e:
<br />.it',..",fyrhrn,rrp.rlni,mtucotrhc$oikfdwlrRhrhi!Jrnir is rssucd. I sIrll nor cmpk'y rtry ncrotr ir atry mrtrncr
<br />h s ro bcdnm n$lccr ro rhc wortcF con{c \arion laws orcrlilnrnix.,nd n8m rhd ill should tEcoaE ub]cd ro lhc
<br />*or[c6 co.nncnsalion pmvnbm olSmri,,n.]70Oolrh. tihr Cel..l shnll. fonhwirh conrDly wiln rhoc Imvision\
<br />WAlrNIN(;: Fdlurc b sccurt workcrs .onwnsain,n covcrusc h !nk*lil. itrd rhlll suhjc.t ,tr c ploycr lo criminrlp.nulris lnd
<br />civil lincs up ro otrc hundr.d rhousrnd dolhr\ lsllx).(x)). i! rddirion b rlt..i of..nrP.trrdi.n, d.nEscs !s lrolidcd ror rhc
<br />rhc t]txtr (n.1.. inrcr.{ xnd itrmltl
<br />DECI,AN{IDN
<br />I hcrc6y alliru undcr l{rrlly of pcrjtrrr rhnr I r'n tutd\ti uid.r nn,vnion ol('h.nlct I (comrmncin8 sirh Scri'n ?(XD) ofDivisn l
<br />ol lhc susinc$ d PDIi$ion\Co{lc, d 'nyliccn{ n in iuu tor.c anlcalccr.
<br />cl)x tru(:Ill)NrlNDtNli-dtrlcr
<br />Ihcrctryalitnrundcrpcnrlryoltrrju'lrhdrhcrci\rco.{rucri,,nkiinerBcncylnrrlEncrlotnunccofrhcworklirwhi.hrhisFrnriris
<br />rsu.d (Sc. 1097. Civ C.).
<br />ATIIICANLDECT.AEAIJON
<br />I lrr$y altnnr undcr ncnrlry ol lcrjury orc ofrhc tollowina dccluriotr\:
<br />lxmolirionPcrnirlAsb.nos Nolinc iooFcdcral Rc8ularions(lnti{)-l'rn6)
<br />Rcqun.d b(cr olNolifi calion
<br />__tl .ailyrhr'rhclc,ic'rlrgulr'nn\r.Gfld'ngJ\h.rn.r.nmvrln r.rJnrltrJhhr.r\rnroi(r
<br />{U.d'ryrhd Itukr.drrhnr {rri.n ad iarc rhar rhc unovc inromurn'n is corer IaEer,.oq)lyRilhallcn,rndcounry
<br />Unr8..nslrucridr, rtrl ftrcby urhri/d rcprr\.darirc\ of rhi\o'diria ..s dd Srdr. l-dss rld irE
<br />a ilNw
<br />CiryMd cornlylo cnlcr utotrlhc
<br />" >l 7'l!3
<br />Set Backs ioQ rL1,!/ u'\- ,|2
<br />Erection Pads
<br />UFER Ground \
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathing 7lLlt9 1/4{/i/
<br />Shear Wall llri'lrz 17,1€r)
<br />Framinq ittl lB vdm
<br />lnsulation/Enerqy '7lzsl N.
<br />'vtvy
<br />Drywall I
<br />Ext./lnt. Lath fldrP' i QszrtA-/01-
<br />Brown Coat 9ltbl-ft 'iLtt-v,,t '>1)
<br />lr/asonry t U !
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report \
<br />Flood Zone Certif .
<br />FINAL :4NrQ -ttV*r,zlt t,2rh )
<br />Certificate ol Occupancy u'l
<br />NotQs, Remarks, Etc.
<br />6ltt,lr aQ..t
<br />l1 T'l
<br />)
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />txnd./! Addrcs
<br />-
<br />arL- Alol,.t'
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